1. has a license or other authorization required by the state of intended employment to practice medicine if the physician will perform direct patient care and the state requires the license or authorization, and
    

2. has a full and unrestricted license to practice medicine in a foreign state or has graduated from a medical school in the United States or in a foreign state.

• is coming to the United States primarily to teach or conduct research, or both, at or for a public or nonprofit private educational or research institution or agency, and that no patient care will be performed, except that which is incidental to the physician's teaching or research; or
   
• the alien has passed the FLEX (Federation Licensing Examination) or an equivalent examination as determined by the Secretary of Health and Human Services. HHS has determined that the following examinations are equivalent to the FLEX: Parts 1, 2, and 3 of the National Board of Medical Examiners (NBME) exam or Steps 1, 2, and 3 of the U.S. Medical Licensing Examination (USMLE). It is not acceptable to "mix and match" portions of the NBME and USMLE.
  
  and
  
   

  i.	has competency in oral and written English which shall be demonstrated by the passage of the English language proficiency test given by the Educational Commission for Foreign Medical Graduates; or
  ii.	is a graduate of a school of medicine accredited by a body or bodies approved for the purpose by the Secretary of Education; or

  
  

• is coming to the United States primarily to teach or conduct research, or both, at or for a public or nonprofit private educational or research institution or agency, and that no patient care will be performed, except that which is incidental to the physician's teaching or research; or

An H-1B petition for an alien graduate of a U.S. medical school shall be accompanied by evidence that the physician has a license or other authorization required by the state of intended employment to practice medicine if the physician will perform direct patient care and the state requires the license or authorization. The FLEX Examination is not required.

H-1B Visa Status is available to a Canadian physician (more precisely, a graduate of a Canadian medical school regardless of citizenship) on the same terms as all other foreign medical graduates i.e. he/she must have passed the FLEX, NBME, or all three parts of the USMLE. The fact that the Canadian trained physician may have, or be eligible for, a license to practice medicine in a State DOES NOT exempt him from the examination requirements. Since Canadian citizens do not need a nonimmigrant visa to enter the U.S. he/she may seek entry at any U.S. port of entry upon receipt of a Notice of Approval (Form I-797) of the H-1B petition.

TN status pursuant to the USA/Canada Free Trade Agreement is also available to a Canadian physician (who must be a citizen of Canada) in the following circumstances:

The FLEX Examination is not required.

In order to obtain TN Status the Canadian physician appears at a U.S. port of entry with documents establishing eligibility. This would normally include a letter from the hospital which describes the position offered; states that the position involves primarily teaching or research; and states that any patient care is incidental to the teaching or research. Also required are the medical school diploma, state license, proof of Canadian citizenship, and $50.00 filing fee. No prior approval is necessary. However, it is possible to ask for a preliminary review of the documents at some ports of entry in order to avoid any last minute disputes over eligibility. Entry is authorized in increments of one year. Unlike H-1B Status, there is no six year limitation.